Antithymocyte globulin before transplantation for patients with acute myeloid leukemia

This study aimed to analyze the impact of antithymocyte globulin doses in patients with acute myeloid leukemia in first complete remission undergoing transplantation.

This study concluded that an antithymocyte globulin dose less than 6mg/kg is enough to prevent graft versus host disease. Doses higher than this impair disease control and outcome. 

Antithymocyte globulin (ATG) is commonly used to prevent graft versus host disease (GVHD) in patients who are undergoing a transplant from an unrelated donor. GVHD occurs when the transplanted cells see the body as foreign and begin to attack it.

Reduced intensity conditioning (RIC) is a regime that uses reduced doses of chemotherapy and radiation. It was unknown if ATG would be useful in acute myeloid leukemia (AML) patients undergoing a transplant from a matched donor, after RIC.  

This study involved 234 patients with AML. Patients were split into two groups based on the dose of ATG they received. 39 patients received the high dose (6 mg/kg or more). 195 patients received the low dose (less than 6 mg/kg).

Acute GVHD was found in 21% of the high dose group compared to 13% in the low dose group. Chronic GVHD was found in 19% of the high dose group compared to 18% in the low dose group. The rate of relapse was 52% for the high dose group compared to 26% of the low dose group. Relapse led to impaired outcome for patients. 

This study concluded that doses of less than 6 mg/kg ATG are sufficient for GVHD prevention. Higher doses lead to impaired disease control and outcome. 

Consult your physician about ATG treatment.